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LARYNGITIS

Most acute cases caused by respiratory virus.

  • Rest at home including voice rest (best treatment)

  • Avoid talking, use voice sparingly (hoarseness lasts 3–14 d)

  • Use warm sialogogues (e.g. hot lemon drinks)

  • Avoid whispering

  • Drink ample fluids, especially water

  • Avoid smoking and passive smoke

  • Use steam inhalations (5 mins tds)

  • Humidity helps, esp. hot steamy showers

  • Use cough suppressants, esp. mucolytic agents

  • Use simple analgesics, e.g. paracetamol or aspirin

LEAD POISONING (PLUMBISM)

All Australians should have a blood level <10 mcg/dL. Levels above this are associated with adverse neurocognitive defects.

Children at risk of elevated blood lead:

  • aged 9–48 mths living in or visiting older houses with peeling paint

  • those with pica

  • those living in lead-contaminated areas (e.g. heavy traffic, lead mining, battery breaking yards)

Symptoms, which are now rare, include:

  • bad taste in mouth

  • lethargy/fatigue

  • musculoskeletal aches and pains

  • abdominal discomfort

  • irritability/abnormal behaviour/cognitive defects

  • bowel disturbances

Consider lead toxicity in children presenting with developmental delay or behaviour problems and in those with unexplained iron-deficiency anaemia. Active management needed if blood level is >40 mcg/dL. Treatment involves chelation with sodium calcium edetate, succimer or dimercaprol in hospital. Penicillamine or succimer are oral preparations which can be used.

LEG PAIN

Table L1Pain in the leg: diagnostic strategy model

Spinal causes of leg pain

Problems originating from the spine are an important, yet at times complex, cause of pain in the leg. Important causes are:

  • nerve root (radicular) pain from direct pressure, esp. sciatica (L4–S3) (see Vertebral dysfunction with radiculopathy (sciatica))

  • referred pain from:

    • – disc pressure on tissues in front of the spinal cord

    • – apophyseal joints

    • – sacroiliac joints

  • spinal canal stenosis causing claudication

Vascular causes of leg pain

Occlusive arterial disease

Acute lower limb ischaemia

Sudden occlusion whether by embolism or thrombosis is a dramatic event which requires immediate diagnosis and management to save the limb.

Signs and symptoms—the 6 Ps

  • Pain

  • Pulselessness

  • Pallor

  • Paralysis

  • Paraesthesia or numbness

  • ‘Perishing’ cold

Management of acute ischaemia

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